<!DOCTYPE html>
<html>

	<head>
		<meta charset="utf-8">
		<meta http-equiv="X-UA-Compatible" content="IE=edge">
		<meta name="viewport" content="width=device-width, initial-scale=1">
		<title></title>
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			<script src="//cdn.bootcss.com/html5shiv/3.7.2/html5shiv.min.js"></script>
			<script src="//cdn.bootcss.com/respond.js/1.4.2/respond.min.js"></script>
		<![endif]-->
		<link rel="stylesheet" href="css/mobile-select-area.css" />
		<script type="text/javascript" src="js/jquery-1.11.2.js"></script>
		<script type="text/javascript" src="js/dialog.js"></script>
		<script type="text/javascript" src="js/mobile-select-date.js"></script>
	</head>

	<body>
		<div class="text-center me-center">网络办卡</div>
		<div class="container-fluid">
			<div class="buzou text-cen blue">
				<div class="bz-num clearfix">
					<div class="fl bz-num-01">
						<div class="yuan-blue">1</div>
					</div>
					<div class="fl bz-num-02 ">
						<div class="yuan-blue ">2</div>
					</div>
					<div class="fl bz-num-03 gary">
						<div class="yuan-blue yuan-gary">3</div>
					</div>
					<div class="border-blue-01 "></div>
					<div class="border-blue-02 border-gary-02"></div>
				</div>
				<ul class="bz-num-zi clearfix">
					<li class="fl bz-num-01">初步审核</li>
					<li class="fl bz-num-02 ">信息填写</li>
					<li class="fl bz-num-03 gary">提交成功</li>
				</ul>
				<p class="bk-p-01">请完成基本信息填写，求真相！</p>
			</div>
		</div>
		<p class="bk-p-05"><strong>标准银联个人普卡</strong></p>
		<div class="container-fluid">
			<p></p>
			<div class="container-fluid">
				<form role="form">
					<div class="row">
						<div class="col-xs-4"><label for="applyEmail">电子邮件</label></div>
						<div class="col-xs-8"><input type="text" class="form-control" id="applyEmail" placeholder="电子邮件"></div>
					</div>
					<div class="row">
						<div class="col-xs-4"><label for="pccc_applyName">姓名</label></div>
						<div class="col-xs-8"><input type="text" class="form-control" id="pccc_applyName" placeholder="董海洋" readonly="readonly"></div>
					</div>
					<div class="row">
						<div class="col-xs-4"><label for="pccc_certNo">姓名拼音</label></div>
						<div class="col-xs-8"><input type="text" class="form-control" id="pccc_certNo" placeholder="DONG HAIYANG"></div>
					</div>
					<div class="row">
						<div class="col-xs-4"><label for="address">身份证有效<br/>期起始日期</label></div>
						<div class="col-xs-8">
							<input type="text" class="shengshi_address form-control" id="txt_date" value="1960/09/12" readonly="readonly" />
							<input type="hidden" id="hd_area" value="12,124,3269">
						</div>
					</div>
					<div class="row form-group">
						<label for="pccc_applyTel" class="col-xs-4">最高学历</label>
						<div class="col-xs-8">
							<select class="form-control">
								<option value="" selected="selected">请选择</option>
								<option value="0">研究生或以上</option>
								<option value="1">大学本科</option>
								<option value="2">大专</option>
								<option value="3">高中</option>
								<option value="4">中专</option>
								<option value="5">初中及以下</option>
					      </select>
						</div>
					</div>
					<div class="row form-group">
						<label for="applyEducation" class="col-xs-4">卡片寄送至</label>
						<div class="col-xs-8">
							<select class="form-control" id="applyEducation" name="applyEducation">
								<option value="" selected="selected">请选择</option>
								<option value="0">单位地址</option>
								<option value="1">家庭住址</option>
					      </select>
						</div>
					</div>
				</form>
			</div>
		</div>
		<a class="text-center me-center" id='send' href="new4.html">下一步：填写住宅信息</a>
		<script>
			var selectDate = new MobileSelectDate();
			selectDate.init({
				trigger: '#txt_date',
				min: '1960/01/01',
				max: '2016/02/11'
			});
		</script>
	</body>

</html>